The vaginal opening is not able to stretch sufficiently
to accomodate the baby's head, especially during a first
pregnancy. As a result, when the baby's head pushes down in
the second stage of labour, it causes a tear. Tearing
towards the back passage is most common and least painful
whereas tearing towards the front can be very painful.

Tears can be of different degrees:

First-degree: this is the least severe
tear and is superficial.

Second-degree: this tear involves the
skin as well as the muscles of the vagina and those that
lie beneath.

Third-degree: the most severe kind of
tear, this involves the muscles of the back passage and
will need to be stitched up be a senior doctor.

If your midwife feels that your
perineum (area between vagina and anus) is not stretched
enough to allow the baby's head to come through and that
you might tear badly, you may be offered an episiotomy. An
episiotomy is a small cut made with scissors at the vaginal
entrance to widen it so that the baby has more room to come
through. You will require stitches if you have an
episiotomy. Some hospitals routinely perform episiotomies
as compared to others.

Although stitches used are soluble and will dissolve
after about 9-10 days, the wound will still continue to
hurt and you will feel very sore. This pain is made worse
by the swelling and bruising experienced during labour.

You can try and help yourself by the following:

* Always sit between two pillows (one pillow to support
each buttock), so that you reduce any pressure on the
perineum.

* Use a cooling cushion
for continued relief

* If sitting down on pillows also hurts, try to sit on
an inflatable rubber ring.

* Have a warm bath with only common salt added in the
water.

* This will help heal the stitches faster.

* If your stitches sting on passing urine, pour some
warm water on them while urinating. This will help to
dilute the acidity of the urine and prevent stinging.

* After passing urine, clean the area well using fresh
water (preferably through a shower head). You can add
savlon to the water as well.

* Keep the stitches clean and dry.

* When you empty your bowels for the first time after
delivery, it can be a very painful experience. You can help
minimise the pain on the stitches by pressing a sanitary
towel against them and leaning as forward as possible on
the toilet seat. Never worry that your stitches will come
out with the pressure when emptying your bowels.